Emphasizing Care And Conscience Over Productivity Quotas

I am now in my seventh month of retirement after 34 years as a small town podiatrist. I miss the patient care but must admit that life is great. I am camped on the shore of Hood Canal on the Olympic Peninsula of northwest Washington. The weather is perfect. My wife of 40 years is trying to rein in our nasty 2-year-old Cavalier King Charles spaniel. Never buy a dog just because he is cute.

I have spent a lot of time reflecting on my 34 years as a podiatrist. I did a lot of things right but really neglected one aspect of practice, namely practice management. Just being a good doctor was always on the front burner and practice management was in the warming tray. Having a solid business plan was important to me but tweaking it for growth and increased profit never excited me.

The doctors who were into practice management when I started tended to be marginal practitioners who learned a few surgical tricks in weekend seminars and then used their practices to troll for patients who were willing to try “something new and exciting.” Our profession was stained with the stigma of high volume same-day “surgeons.” Patients would walk in for a first visit and limp out an hour later with their feet covered with tiny incisions and bones drilled here and there to balance metatarsals and reduce “exostosis.”

The emergence of good surgical residencies and the growth of our professional image has all but eliminated these zip mills. Thank God for that.

There is a place for practice management in our profession. The economic challenges faced by practicing physicians make it essential for them to have a plan to sustain business. Practice management that is based on good, ethical solid business planning is okay with me.

Practice management that is based on increased productivity and surgical volume is a lot like buying a car from a high pressure, gum-popping salesman with a quota to meet. He is going to beg, plead and use every trick in the book to make that sale. Doctors with productivity goals are similar but more dangerous. If you buy a car you do not need, the worst that can happen is that you could go broke. Unnecessary surgical care has far more drastic consequences.

My practice could have been more successful if I at least had practice management on the stove top. I only attended one practice management course during my career. A couple of clowns spent three days lecturing us on playing the numbers game with diagnostic and procedure codes. We also learned how to put enough “bullets” into the documentation to justify the high fee and make us audit proof. All this stuff was cool. You could trim a hangnail and bill it as a level 3 examination and assessment, and then bill a surgical code for nipping the toenail. Ka-ching! It was $250 for seven minutes of work. I did not stay for the whole course.

I like that I can walk down the street in my small town and know I will never see a former patient who got worked over financially in my office. The young men who took over my practice are better at practice management but have the same sense of devotion to patient care. They kept my business model of “no financial barriers to care.” They are well-trained surgeons with no need to push that aspect of podiatric care.

The best part of the whole thing is the way my former patients treat me. I received Father’s Day greetings from many of my younger patients. Those were much more meaningful than a pot of gold I might have collected with aggressive productivity goals.

I visited a medical clinic a few months ago. A small sign on the wall said “Doctors With No Love Of People Are Merely Technicians.” I am just guessing but I do not think that doctor had a productivity quota.

Examine your professional conscience. If you have goals or quotas that involve pushing lucrative service, consider putting them on the back burner or in the warming tray. At some point in your life, you are going to have to face your patients and there is nothing better than a warm greeting and gratitude they show you for being a good doctor to them.

Now I am going to rescue my wife from that yappy little barking bedroom slipper. It is time for a walk on the beach.